BAD BREATH

Causes of bad breath ?

Bad breath is a common health problem which greately affects the daytoday
activities of somany people. The offenssive odor from the mouth is unpleasent to
those who come in close contact with bad breathers. The problem will be doubled by
psychological trauma leading to depression. The sufferers from this problem wil be
isolated from the society. This can even lead to marital disharmony.

Literally speaking all humanbeings are badbreathres. Oral cavity contains millions
of anaerobic bacteria like fusobacterium and actinomyces which acts on the protein
of food materials and putrifies them. This process results in the formation of
offenssive gases like hydrogen sulphide,methyl
mescaptan,cadaverin,skatol,putrescine ect causing bad odor. If oral hygiene is not
maintained properly all will suffer from bad breath. Most of us control this by
regular brushing,tongue cleaning and gargling. Even after maintining cleanliness in
the mouth some individuals suffer from offenssive smell due to various causes which
has to be diagnosed and treated properly.

Some common causes of bad breath.

1) Poor oral hygiene:

If oral hygiene is not maintained properly the mouth becomes the seat for millions
of bacteria which produce offenssive gases by degrading the food debris. Bad breath
is severe in those who do not brush their teeth regularly and clean their mouth
after every food. Snacks taken inbetween meals can also produce bad breath because
of improper cleaning.
Badbreath is common in almost all people in the morning on waking. During sleep
there is less production of saliva .Saliva has got some antibacterial properties
which help to keep the mouth clean. Saliva conains oxygen molecules which is needed
to make oral cavity aerobic. So the reduction in it's quantity during sleep makes a
favourable condition for anaerobic bacteria.

2) Food habits:

The main cause of bad smell is due to degradation of protein by the bacteria and
hence all food products rich in protein favours bad breath. Meat,fish,milk
products, eggs,cakes,nuts,pear and ect can cause bad breath. Some food articles can
produce particular type of smell which may be unpleasent. Raw onion can produce
typical bad smell. It is said that an apple a day keeps the doctor away,a raw onion
a day keeps everybody away. Eating groundnuts can also produce bad smell. However
if proper cleaning is done smell can be reduced irrespective of the nature of food.
Irregularity in timing of food can also produce bad breath. Small food articles
taken in between the meals can also produce bad smell.

3) Biofilm:

There is formation of a thin sticky coating called biofilm on the tongue and oral
mucosa. This coating is thick on the posterior aspect of the tongue where millions
of gram negative bacteriae are seen .The thick coating on the tongue is always
associated with badbreath. Even a thin biofilm can make anaerobic condition
favourable for bacterial proliferation.

4) Dental caries:

This is a destructive process causing decalcification with distruction of enamel

and dentine resulting in cavitisation of the tooth. These are produced mainly by
the lactobacilli . Food particles are deposited inside these cavities and are
putrified by the anaerobic bacteria producing bad smell. Normal brushing will not
remove the food debris easily and hence they are putrified completely. Caries are
common in schoolgoing children and in those who donot maintain proper oral
hygiene .Calcium and vitamin deficiency can also predispose caries.

5) Gingivitis:

Gum is a mucus membrane with supporting connective tissue covering the tooth
bearing borders of the jaw .The main function of gum is protection .Gingivitis is
the inflammation of the gum .Due to various causes gum tissue get infected
resulting in swelling,pain and discharge. If the condition become worse the
infection spread towards peridontal area leading to continuous discharge called
pyorrhoea. Some times the infection goes deep producing alveolar abscess with
discharge of pus. Infection can even reach the bone causing osteomyelitis.All these
conditions can produce offenssive smell.

6) Gum retraction:

When the gums retract from the teeth a gap is developed which will lodge food
particles and cause bad breath.

7) Dental plaques and tartar deposits; Plaques and tartar is deposited mainly in
the gaps between the teeth and gum. This will provide shelter for the food debris
and bacteria causing bad breath.

8) Ulcerative lesions& coatings:

Almost all ulcerative lesions of the mouth are associated with bad breath. These
lesions may be caused by bacteria,viruses,food allergies or due to autoimmune
disorders. Apthous ulcer is the commonest amoung ulcerative lesions. Others are
herpes,fungal infections,vincents angina,infectious mononucleosis,scarlet
fever,diphtheria,drug reactions and ect. Cancerous ulcers produce severe bad
breath. All fungal infections produce white coating(candidiasis). Leucoplakia is a
white thick patch on the mucus membrane of the mouth & tongue. It is considered as
a precancerous condition. Offenssive breath is associated with these conditions.

9) Diseases of the salivary glands:

Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin
film of coating called biofilm can provide an anaerobic condition in the mouth.
Saliva can wet these layers and make an aerobic condition which is unfavourable for
the bacteria .Any condition which reduces the production of saliva can increase
bacterial activity. Some times the salivary duct is obstructed by stones or
tumors.Cancer of the salivary gland is associated with offenssive odor. In
suppurative parotitis purulant dischrge in to the mouth causes bad breath.

10) Tonsillitis:

Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx.
Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute
and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad
breath.

11) Tonsillar plaques & tonsillar fluid:

If bad breath persists even after maintaining proper oral hygeine there is
possibility of this condition. Serous fluid secreated from the folds of tonsil is
very offenssive. Some patients complain that they hawk some cheesy materials from
the throat;which are very offenssive in nature. These are formed inside the
tonsillar crypts which contain thousands of bacteriae. In such conditions
tonsillectomy gives noticiable relief from bad breath.

12) Pharyngitis& pharyngial abscess:

Pharynx is a fibromuscular tube which forms the upper part of the digestive &
respiratory tract. Inflmmation of the pharynx is called pharyngitis, caused mainly
by bacteria and viruses. Bad breath is present in pharyngitis along with other
signs like cough and throat irritation. Abscesses in the wall of pharynx can also
produce offenssive discharge of pus in to the throat.

13) Dentures:

Denture users may complain about bad smell due to lodgement of small food debris in
between. Proper brushing may not be possible in denture users especially fixed
dentures.

14) Tobacco:

Tobacco chewing is associated with
unpleasent for others. Tobacco can
coatings. Gingivitis and pyorrhoea
deposited on the teeth mainly near
with eructations. All these causes
bad breath. The smell of tobacco itself is
irritate the mucus membrane and cause ulcers and
are common in tobacco chewers. Tartar is
the gums. Tobacco chewers get gastric acidity
offenssive smell.

15) Smoking:

Smokers always have bad smell. It can also produce lesions in the mouth & lungs
causing bad breath.Smoking increases carbon dioxide in the oral cavity & reduces
oxygen level,causing a favourable condition for bacteria. Smoking reduses appetite
& thirst hence acid peptic disease is common in chain smokers.

16) Lesions in the nose & ear:

Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In

case of post nasal dripping bad breath is common due to the presence of protein in
the discharges. These proteins are degraded by the bacteria. Infection in the
middle ear with discharge of pus in to the throat through the eustachian
tube(passage from middle ear to the throat)can also cause offenssive odor. Chronic
rhinitis(infection of mucus membrane of nose) and forign bodies in the nose can
also produce bad smell in the expired air.

17) Diabetes mellitus:

Mostly all diabetic patients suffer from bad breath. Coated tongue,ulcers &coatings
in the mouth ,increased sugar level in tissues ect are responsible for bad
breath.Bacterial growth in diabetic patient is very faster than non diabetic
individuals.

18) Fevers:

Bad breath is common in almost all fevers. Even an acute fever can produce bad
breath. Severe bad breath is seen in typhoid .Other infectious diseases like
Tuberculosis , AIDS ect produce bad smell.

19) Fasting & dehydration:

Dry mouth favours bacterial activity. So any condition which produce dryness in the
mouth makes the breath offenssive. Eventhough the food particles are known to
produce bad breath, fasting can also produce the same. Production of saliva is also
reduced during fasting. Chewing and swallowing also helps to keep the mouth clean.

20) Bedridden patients:

Bedridden patients suffer from offenssive breath due to thick coating on the
tongue. water intake is also limited in these patients. Regurgitation of food
aggravates the condition. Since they talk less aeration in the oral cavity is
reduced which favours anaerobic bacteria to become active.

21) Diseases of stomach & esophagus:

Eructation of gas and food produce unpleasent smell. Abnormality in the function of
lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad
breath is also common in gastritis,gastric ulcer and cancer of stomach.

22) Intestinal diseases:

Bad breath is common in patients suffering from ulcerative lesions of intestine

like ulcerative collitis..Other diseases are malabsorption syndrome intestinal
tuberculosis, peritonitis ect.

23) Diseases of lungs:

Lung diseases like pneumonia, lung abscess,chronic

bronchitis,bronchiectasis,tuberculosis, lung cancer ect can produce bad odor during
expiration.

24) Liver disorders:

Liver diseases like hepatitis, cirrhosis,can cause bad breath.Gall bladder

diseases with vomiting also causes unpleasent odor.

25) Psychiatric patients:

Bad breath is common in psychotic patients due to poor hygiene,irregular food

habits,less water intake and ect.

26) Somatisation disorder:

This is a psychiatric disorder charecterised by the presence of a physical symptom

that suggest a medical illness .These patients come with physical complaints like
pain,nausea difficult respiration, bad smell ect. This condition is diagnosed after
detailed examination of the patient with all investigations.Since this is a
psychiatric disorder it has to be managed with a psychological approach.

[ THE POINTS MENTIONED IN THIS ARTICLE IS FOR GENERAL INFORMATION. ANY PERSON
HAVING BAD BREATH SHOULD CONSULT A QUALIFIED DOCTOR ]